disturbances of carbohydrate metabolism. diabetes mellitus. the state education institution of...
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Disturbances of carbohydrate
metabolism. Diabetes mellitus.
The State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical University
under Ministry of Health of the Russian Federation
Lecture presentation
Professor Pirozhkov S.V.
Department of Pathophysiology
2014-2015 education year
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TYPICAL FORMS OF DISORDER OF TYPICAL FORMS OF DISORDER OF CARBOHYDRATE NETABOLISMCARBOHYDRATE NETABOLISM
●● Hypoglycemia (< 3.3 mmol/L of blood)
●● Hyperglycemia (> 5.6 mmol/L of blood)
●● Glycogenoses
●● Aglycogenoses
●● Pentosemia, hexosemia
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CAUSES OF HYPOGLYCEMIACAUSES OF HYPOGLYCEMIA
● Neurogenic
● Endocrinogenic
● Hepatic
● Renal
● Inadequate substrate supply
● Use of drugs
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SYMPTOMS OF HYPOGLYCEMIA
I. Associated with activation II. Associated with glucose
of the sympathetic system deprivation of the brain
(autonomic response) (neuroglycopenia)
● sweating ● dizziness
● tremor ● headache
● tachycardia ● blurred vision
● anxiety ● poor reasoning
● sharp sensation of hunger ● ataxia
● confusion
● seizures ● loss of consciousness
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CAUSES OF HYPERGLYCEMIACAUSES OF HYPERGLYCEMIA
● Neurogenic
● Endocrinogenic
● Alimentary
● Hepatogenic
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Diabetes mellitus is a disease or syndrome characterized by systemic derangements of carbohydrate, lipid and protein metabolism, acid-base and water-mineral balance, resulting from absolute or relative deficiency of pancreatic insulin
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Epidemiology of diabetes mellitus Epidemiology of diabetes mellitus (DM):(DM):
► Worldwide, more than 140 million people suffer from DM.
► Approximately 80% to 90% of patients have type 2 DM.
► DM increases with ageing. In 2000 the prevalence of DM was:
0.19% in people < 20 years old;
8.6% in people > 20 years old;
20.1% in individuals > 65 years old
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Insulin deficiency
KETOACIDOSISPOLYPHAGIA HYPERGLYCEMIA
GLUCAGON EXCESS
Muscle
Kidney
Adipose tissue
Increased lipolysis (free fatty acids)
Increased protein catabolism (amino
acids)
Liver
Gluconeogenesis
Ketogenesis
Metabolic derangements typical for diabetes mellitus type I
POLYURIA
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MAIN MANIFESTATIONS OF METABOLIC DISORDERS IN DIABETES MELLITUS
MAIN MANIFESTATIONS OF METABOLIC DISORDERS IN DIABETES MELLITUS
CARBOHYDRATES PROTEINS LIPIDS WATER
Hyperazot-emia, increased blood urea nitrogen
Hyper-glycemia
Glucose-uria
Hyperlactacidemia
Azoturia
ACIDOSIS
Hyper-lipidemia
Ketonemia
Ketoneuria
Polyuria
Poly-dypsia
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Genetic aspects of diabetes mellitus type 2:Genetic aspects of diabetes mellitus type 2:
► ► Among identical twins, the concordance Among identical twins, the concordance rate is 70% to 90%rate is 70% to 90%
►► In first-degree relatives with type 2 In first-degree relatives with type 2 diabetes (diabetes (and in non-identical twinsand in non-identical twins), the ), the risk of developing disease is 5 to 10 risk of developing disease is 5 to 10 times higher than in age- and weight-times higher than in age- and weight-matched subjects without a family matched subjects without a family historyhistory
► ► Unlike type I diabetes, the disease is not Unlike type I diabetes, the disease is not linked to any HLA genes linked to any HLA genes
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Phases of the clinical course of diabetes mellitus type 2Phases of the clinical course of diabetes mellitus type 2
Resistance Blood insulin Blood glucose to insulin concentration level
I phase moderately increased normal increased
II phase greatly increased hyperglycemia increased after meal
III phase greatly insufficiently hyperglycemia increased increased for in the fasting a particular state glucose level
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CHRONIC COMPLICATIONS OF DIABETES MELLITUSCHRONIC COMPLICATIONS OF DIABETES MELLITUS
► Microvascular
● Eye disease
- retinopathy (nonproliferative/proliferative)
- macular edema
● Neuropathy
- sensory and motor (mono- and polyneuropathy)
- autonomic
● Nephropathy
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CHRONIC COMPLICATIONS OF DIABETES MELLITUSCHRONIC COMPLICATIONS OF DIABETES MELLITUS
► Macrovascular ● Coronary artery disease
● Peripheral vascular disease
● Cerebrovascular disease
► Other
● Gastrointestinal (gastroparesis, diarrhea)
● Genitourinary (uropathy/sexual disfunction)
● Dermatologic (pigmented pretibial papules)
● Infectious
● Eye diseases (cataract, glaucoma)